Global Healthbeat: Good News from Africa - Measles Deaths Decline

Six years ago, 2001, The Measles Initiative was launched to reduce the number of deaths by measles. In 5 years time, 360 million children around the world were vaccinated and measles deaths in Africa subsequently plunged by 74%. Today, the World Health Organization (WHO) reports that death due to measles in Africa have declined by 91%. 478 million children aged 9 months to 14 years have now been vaccinated. The Initiative now plans to move expand its efforts into Southeast Asia, where there were 178,000 measles related deaths in 2006. 600 children under age 5 die from measles each day.

Some countries are integrating the measles vaccination efforts with other child survival initiatives:

• Vitamin A
• Polio vaccine
• De-worming medicine
• Insecticide-treated bed nets for malaria prevention (21 million beds were distributed in 2006)
  

Measles has been practically eradicated in the Americas, so even clinicians have no direct experience with the disease. It is a highly contagious viral illness spread by droplets from coughing and sneezing. Symptoms are similar to most viral illnesses - sore throat, runny nose, cough, myalgias, fever. Distinguishing features are the red, itchy rash that appears and may last up to week, sensitivity to light, bloodshot eyes, and white spots inside the mouth. Supportive care, bed rest, fluids, supplementation with vitamin A and anti-viral medications are the only treatment. Complications can include secondary infections such as pneumonia, encephalitis, otitis, bronchitis. Immunization is recommended for all children.

Thank you Teseum for use of photo Looks.

Labels: global health, immunizations, measles

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Protect Your Brain - Eat More Salmon, Eggs and Walnuts

I have written before about the benefits of Omega 3 fatty acids. Now scientists at the Universite Laval provide us with one more reason to eat a diet rich in omega-3 fatty acids: they may protect the brain against progressive neuron death - a factor in Parkinson's disease.

Researchers at MIT have found that a cocktail of DHA omega-3 fatty acids, uridine and choline
may hold promise for promoting the growth of new brain connections and improving cognitive function. This treatment may offer hope for Alzheimer's disease victims as well as other brain injuries and diseases. The cognitive decline in Alzheimer's patients is due to loss of synapses within the brain and researchers are searching for ways to restore synapses. Learning, memory and other information is passed from neuron to neuron within the brain via synapses.

Omega-3 fatty acids are found in fish, eggs, flaxseed, walnuts and meat from grass-fed animals. For more reading about this vital supplement, read:

• Omega-3 fatty acids
• Omega-3 and Omega-6 fatty acids
• Fishing for Omega-3's
• Add 20 Years to Your Life
• Essential Fatty Acids
• Fish oil
• Stalking the Wild Omega-3s
• Omega-3 eggs
• Good sources of Omega-3's
• The Wonder of Walnuts
• Good Things Come in [Omega] Threes
• The Omega Balance

Thank you funadium for use of Walnuts - Noci photo.

Labels: cognition, omega-3's brain function

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Alcohol Use Disorders - Taking Their Toll

Fermented beverages have been part of human culture and traditions for thousands of years. Altering our brains and achieving intoxication is pleasurable to most humans and some animals. Intoxication, like sex, is fun, or we wouldn't do it. Ron Siegel, who has studied the subject extensively, say we seek intoxication to experience something outside our normal experience and take "a holiday from reality". It goes deeper than that, though. When we are in pain, be it psychic or physical, we need something to calm and sedate us and when we are depressed or bored we seek stimulation. The observations of psychoanalyst Carl Jung influenced the founding of AA when he found that a patient's "craving for alcohol was the equivalent...of the spiritual thirst of our being for wholeness...the union with God."

Jung goes on "You see 'alcohol' in Latin is 'spiritus' ...use the same word for the highest religious experience as well as ...the most depraving poison. The helpful formula therefore is: spiritus contra spiritum." About 75% of people in the US consume alcohol and almost 25% report abuse or dependence problems. That means we all know and love someone affected by this illness. Men are 2-3 times more likely than women to have alcohol related problems and there is strong evidence of a genetic predisposition to alcohol dependence. Male children of alcoholic fathers are at greatest risk for being alcoholics themselves. Native Americans have a genetic susceptibility to alcoholism. Native Americans have the highest rates of alcohol-related deaths of all population groups in the US.

Costs of alcohol dependence and abuse in terms of violence, traffic accidents, lost productivity, illness and premature death are over $185 billion per years. Complications of chronic alcohol abuse are :

• gastritis, ulcers, esophagitis, hepatitis, cirrhoisi, hepatitis. All of these except cirrhosis can be reversible with alcohol abstinence
• peripheral neuropathy, dementia, Wernicke-Korsakoff syndrome. Alcohol abstinence and vitamin therapy can improve these.
• high blood pressure, fast heart rate - both of which improve with alcohol abstinence
• macrocytosis, folate deficiency, splenic enlargement
• decreased testosterone levels in men, decreased libido, impotence, menstrual irregularities

The National Institute of Alcohol and Abuse and Alcoholism (NIAA) offers a wonderful guide for clinicians, Helping Patients Who Drink Too Much. The guide provides a clinical approach to assessment and treatment of at-risk drinking and alcohol use disorders. The key is to ask about drinking. Five or more drinks per day for men, four or more for women is an at-risk drinker, requiring further assessment. A referral to an addiction specialist may be indicated.

The important thing for family, friends, clinicians who are concerned about problem drinking is to talk to the person calmly and say "I am concerned that you have an alcohol use disorder. It is not a weakness, it is an illness. There are medications and treatment that can help you. If you would like me to help you get help, I would be happy to."

Addressing the problem, treating alcoholism, does not get to the root of chemical dependency - seeking to escape reality, seeking wholeness. That's not a medical problem, but some how we have to make it part of our lexicon of healing chemical dependency. Working with the individual and family to find alternative ways to find peace and wholeness - in church, in prayer, in ritual, in dance, in meditation - has to be part of treating the whole person.

Thank you yeimaya for use of photo of Rehearsal 15.

Labels: alcohol, chemical dependence disorders

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Avoid Food Poisoning on Turkey Day

Half the fun of cooking and getting together with friends and family is drinking a little wine while preparing the food. Don't let the alcohol and festivities go to your brain and make you forget safe food practices:

• Wash your hands often with soap and water
  
• Avoid cross-contamination of foods by keeping raw and cooked foods separated
• Sanitize knives, cutting boards and food contact surfaces
• Keep refrigerated foods below 40 degrees F and frozen foods below 0 degrees F.
• Cook meats at the recommended temperatures, using a meat thermometer
• Mayonnaise kept at room temperature is a common cause of food poisoning - bacteria collect in this rich food if left out of the cold too long.
  

Special precautions for turkey:

• Do not thaw pre-stuffed turkey before cooking
• Thaw turkey in the refrigerator: 24 hours for every 5 lbs. of turkey.
• Never thaw a turkey at room temperature on the counter
• If you choose to stuff your turkey, do so just before cooking and prepare the stuffing right before cooking.
• Turkey is completely done when the internal temperature of the thigh and breast are 165 degrees F.
• It takes about 4.5 hours to cook an unstuffed 20 lb. turkey and almost 5 hours for a stuffed 20 lb. turkey.

Signs of food poisoning?

• Nausea, vomiting, diarrhea, stomach cramps

I always keep Pepto-Bismol tablets handy and take them with me when traveling. Take two at the first signs of nausea. Drink fresh water, ginger ale or other fluids if you feel a little under the weather. For serious illness - seek medical attention!

Thank you The Eggplant for use of photo Turkey Stuffing.

Labels: Thanksgiving safety

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Dysfunctional Family Thanksgiving - Tips for Survival

Cheers to all the lucky souls who look forward to getting together for the holidays. Some of us make up lame excuses to avoid our families. Some us have good excuses (we have to work, we can't afford the air fare, we have rehearsals for upcoming performances). Some of us have to suck it up, face the music and get together with our dysfunctional families. What can we do to survive another year of obligatory bondage and family ritual?

• Make sure you have all of your prescriptions filled for whatever - especially things like migraine headaches. You need to be armed and medicated to get through this.
• Form alliances with family members who genuinely love, respect you and have a good sense of humor.
• Take daily walks with your allies and decompress about dysfunctional behaviors that are getting under your skin.
• Remove children from the toxic environment frequently and play ball or tag with them.
• Discharge negative energy with physical activity and laughter.
• Try not to keep score - you only have a few days to endure.
  
• Do not allow others to disrespect, embarrass, or manipulate you, even if it is your mother or child or _______ (fill in the blank).
• Keep your shields up - don't drink too much and leave your self vulnerable to attack.

Like Pat Benatar said "Love is a battlefield". Don't go it alone. Good luck!

Thank you cloudcloud25 for use of photo Dysfunctional Family Thanksgiving.

Labels: dysfunctional families, survive holidays

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38th World Conference Lung Health: Cape Town, SA

This year's theme was Confronting the Challenges of HIV and MDR in TB Prevention and Care. TB is a disease of the poor, and researchers complain that the only people interested in developing drugs for a cure are the Bill and Melinda Gates Foundation. No new drugs to treat TB have been developed in 40 years. TB is the number one killer of people with HIV, despite the fact that TB itself is curable.

We have an 80 year old vaccine that doesn't work very well to prevent TB. 2 million people die from the disease every year. Ironic isn't it? In developed countries we are killing ourselves with obesity and sedentary lifestyle related diseases - type 2 diabetes, coronary artery disease, high blood pressure, kidney disease, stroke. Half of the world is eating itself to death, the other half starving to death. In societies already burdened by poverty, hunger, starvation, lack of resources and no access to education people are dying of forgotten diseases.

African sleeping sickness, leismaniasis, filariasis and hookworm claim the lives of millions in undeveloped countries but are unknown in the developed world. The Gates Foundation is funding grants to put these diseases on the global agenda.

Thank you trygveberge for use of photo Tuberculosis.
Thank you Willem & wendy for use of photo of TB patient.

Labels: TB

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Record number of chlamydia cases - 1 million in US

Is everybody forgetting to use condoms? Does everyone think the world is ending and so they don't care any way? I realize the wars and global warming are depressing - but use a condom, people! Gonorrhea, syphilis and chlamydia - all preventable diseases caused by sexually transmitted bacteria - are on the rise, according to the Centers for Disease Control and Prevention (CDC).

Chlamydia rates are highest in black women. A virulent strain of gonorrhea, resistant to ciprofloxacin and other antibiotics has infected over 350,000 people. Chlamydia is a silent infection - without many symptoms - that can damage reproductive organs and result in infertility.
Risk factors are a new sex partner or multiple sex partners. Other than using latex male condoms, if you are in mutually monogamous relationship with a partner and both of you are tested and found to be disease free, you can avoid transmission of STD's. Teen girls and young women are particularly vulnerable because their cervix is not fully mature. Chlamydia can be transmitted by oral or anal sex, so men who have sex with men are also at risk.

Thank you eecue for use of photo.

Labels: chlamydia, condoms, safe sex, STD

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Thank You Dr. Anonymous for Grand Rounds 4.8

Dr. Anonymous had to go all the way to Tucson, Arizona to put Grand Rounds together this week. He gathered 43 posts and my post about EMR's and my new neighbors, Practice Fusion - EMR 2015: Practice Fusion Cuts to the Chase. Thanks for the interesting Grand Rounds, Dr. Anonymous, and pictures of you in one of my favorite places - happy memories with my dad who died of prostate cancer a few years ago. R.I.P.

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26 million US Citizens Face Chronic Kidney Disease - Most Unaware they Have it

The National Institutes of Health (NIH) reports that increased incidence of diabetes, hypertension and obesity are escalating the incidence of chronic kidney disease. Kidney disease is silent - symptoms are subtle - and most folks are unaware they have it. Kidney disease raises the risk of early death, heart attack, stroke, and high blood pressure and can lead to end stage kidney failure requiring dialysis and transplant. People with kidney disease also have anemia, bone disease and malnutrition.

In 2005, dialysis or a kidney transplant services cost the US healthcare system $32 billion, according to the NIH’s U.S. Renal Data System which predicts that by 2020 nearly 785,000 people will be receiving treatment for kidney failure, costing $53.6 billion.

People at risk? Those with diabetes, high blood pressure or family history of kidney disease. If you are in this high risk group, ask your doctor to do some simple tests to check your kidney function:

• Serum creatinine to estimate your glomerular filtration rate (GFR)
• Measure the level of protein in your urine

There is no cure for kidney disease, but it can be controlled by controlling blood sugar and blood pressure. An ACE inhibitor or ARB along with a diuretic should be among the medications used to control blood pressure.

Thank you Mollivan Jon for use of photo Kidney Ferns.

Labels: chronic kidney disease

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EMR 2015: Practice Fusion Cuts to the Chase

EMR? PHR? Everyone wants it, everyone says we need it, but what is it and how should we get it? The US healthcare system continues to be strained by spiraling costs, inconsistent care and inefficient, poorly coordinated delivery. Integration of information technology (IT) has proven to reduce errors and improve outcomes of care across all healthcare settings.

The Electronic Medical Record (EMR) is one way to improve patient safety, manage clinical information and manage care efficiently. Political leaders are advocating universal adoption of EMR, especially in the aftermath of environmental disasters, when people are displaced and access to medical records is lost. Most physician practice groups are small, and the most efficient group practice size financially is reported to be 5 -15 practitioners. Adoption of EMR has typically required capital, disruption of workflow, and intensive training of staff to be operational.

A rowdy group of creative people invaded my office space about a month ago. On October 23, 2007, they launched what may be the ideal solution for individual and physician practice groups - Practice Fusion. Their brilliant solution is web-based - and free. Physicians log on, enter clinical data, connect to patients, other physicians, and healthcare groups. Try the demo at www.practicefusion.com/demo Cost savings realized in transcription costs, chart pulls alone are estimated to be $1.7 billion.

President Bush has called for all US citizens to have EMR's by 2014. Practice Fusion is one pain-free solution for physicians to achieve that goal.

Thank you Google images for use of image.

Labels: EMR, Practice Fusion, quality improvement

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Stemming the Tide of Diabetes: Screening for Pre-Diabetes

Researchers at RTI International, North Carolina report an epidemic of diabetes in the US, correlated to this country's rising rate of overweight and obese people. Thomas Hoerger, Ph.D., author of a study published in Diabetes Care based on research funded by the CDC states that 66% of US citizens are overweight or obese and therefore at risk for developing diabetes.

Their findings recommend pre-screening of at risk adults aged 45-74 with impaired glucose tolerance (IGT) and impaired fasting glucose (IFG), warning signs of progression to diabetes. Once identified, it is recommended that persons with pre-diabetes be treated with a Diabetes Prevention Program lifestyle intervention.

Not only would this enhance quality of life for middle aged adults and seniors, but it will save money to the health care system. Extra weight has been found to not only decrease our expected life span but makes it more take care of ourselves - limiting us in even basic functions like bending over to pick something up. It's not just diabetes that the extra weight puts us at risk for - it's high blood pressure, heart disease, arthritis, cancer, stroke - and now just plain not being able to function.

Obese elderly have a greater risk of being disabled. Sorry to be so blunt about it - but if you are overweight - you increase your risk of death from disease and disability. Move more, eat less, be healthier and live longer.

Thank you Malingering for use of your photo from the ridiculous los angelos series.

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Attention Diabetics: Be Prepared for an Emergency

Earthquakes, fires, floods - we all have to keep our emergency supply kits up to date and well stocked. People with chronic illnesses have to go even further and be prepared to take care of them selves in event of emergency. November is National Diabetes Month. The American Diabetes Association (ADA) offers tips for diabetics who want to be prepared for emergencies and disasters:

Have these extra supplies on hand, along with plastic bags which seal tight:

• Medications and supplies - ADA recommends having 2 weeks worth of supplies on hand:
• lancing devices, lancets, meters and strips, alcohol wipes
• extra socks and skin protection ointment
• For insulin dependent diabetics: syringes, glucose tablets or gel, cotton balls, hand sanitizer, glucagon emergency kit, home sharps container for used syringes, a cold pack
• For users of an insulin pump: extra batteries, remote control, insertion device, infusion set, tape
• ADA recommends having at least a 3 day supply of nonperishable food available at all times:
• canned fruits and vegetables, tuna and other canned meats, beans
• powdered milk or other shelf stable milk, juice, clean water
• Boxed items like crackers, dried fruit and nuts
• Documentation of personal records
• extra prescriptions of each medication that you are on, signed by a doctor
• list of all medications taken and doses
• Contact information for all health care providers, pharmacy, and insurance company
• Diabetes care plan: medication and meal times, record book of blood sugar results

Diabetics should always identify themselves as such to emergency personnel. The ADA has a complete 36 page guide for sale on their website for $4.95 - The Disaster Preparedness Guide for People with Diabetes.

Labels: diabetes, diabetics, disaster, emergency preparedness

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More on MRSA: Online Resources

Folks seem to be having difficulty accessing information and others who have had similar problems with infections. I have been unable to get information about rehabilitation post-infection so I will be looking for some clinicians to interview next week - volunteers? MRSA has killed more people in the US than AIDS... 18,650 deaths in the US were attributed to MRSA in 2005. That number exceeds the number of deaths due to emphysema or homicide.

Here are some other online resources for people who want to look, read or chat with others with MRSA experiences:

• MRSA Resources: a survivor of a near-fatal MRSA septicemia and his wife started this website to encourage others and provide information. This is another case of misdiagnosis with spider bite.
• 
  
• CDC Strategies for Clinical Management of MRSA in the Community : 24 pages of expert advice available on line from the experts
• MRSA and the Workplace from NIOSH (National Institute for Occupational Safety and Health)
• pets-MRSA
  

Are you wondering just what the CDC is doing about MRSA? Here is their statement: What is CDC doing about MRSA? They are doing:

• Surveillance - Data Collection & Statistical Analysis
• Prevention
  
• Epidemiologic and Laboratory Research
• Outbreak and Laboratory Support
• Extramural funding
  

Labels: MRSA, resources, workplace

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